Does oBand Take Insurance for the Lap-Band or REALIZE Band?
December 1, 2011
oBand Surgery Centers and Your Insurance
At oBand® Surgery Centers and Clinics we accept most major Health Insurance Plans. First and foremost you must review you policy to determine if you have the “Benefit” to have weight loss surgery through your Health Insurance. Not all Health Plans cover Bariatric Surgery. This is totally dependent on your employer and whether or not they have purchased the “Benefit” for you.
For instance, your Health Insurance may be through Aetna and your cousin may also have Aetna. You both work for different employers. One of you may have coverage and one may not. Again, it is up to your employer, not the insurance company.
The oBand® team of experts can help you determine whether you have an exclusion or the benefit (inclusion) for bariatric surgery. In the event coverage is not offered, oBand® will continue to present your case if you are a candidate with extenuating circumstances. oBand® will initiate an appeals process with your health insurance on your behalf. We can also assist you with financing.
Some of the Health Plans that we accept include: Blue Cross of California, Blue Shield of California, Blue Cross Blue Shield of Nevada, Blue Cross Blue Shield of Florida and the majority of “Out of State” Blue Cross Blue Shield Plans.
The National Plans that we accept include: Aetna, Cigna, United Health Care, Mailhandlers, GEHA (Government Employees Health Association), Federal Plan Blue Cross Blue Shield, Beech Street, Tri-Care, ILWU (International Longshore and Warehouse Union) and Union Pacific. This is only a partial list. Our administrative team will happily assist you with your insurance.
We are not providers for Medicare, MediCal or any Medicaid programs in the States of Florida or Nevada.
Generally to qualify for Lap-Band or REALIZE Band surgery you must meet the following criteria:
- Be 18 years of age
- Have a BMI (Body Mass Index) of > 40
Or Have a BMI between 35 and 40 and have one or more co-morbidities such as Type II Diabetes, Hypertension, and Sleep Apnea.
Please be aware that these are only general guidelines and a partial list of co-morbidities. Certain Insurance Plans may also cover adolescents.
Specific requirements will be outlined in you Health Insurance Benefit booklet available from your Employer’s Human Resources Department.
Also there may be requirements for a pre-operative diet, documentation of past weight loss attempts, a referral by a primary care doctor, an evaluation by a mental health professional and/or a nutritional specialist. Experts at oBand® Surgery Centers will assist you with all of your requirements and expedite the road to a healthier you.
Some Common Lap-Band Myths (Part 1)
November 23, 2011
1. I will not loose as much weight as a Gastric Bypass Patient if I get the Lap-Band.
Gastric Bypass patients will initially loose their excess weight more rapidly. Lap-Band patients will loose on average 1-2 pounds per week. We consider this slower weight loss a healthier approach with minimal nutritional complications. Also issues with excess skin may also be less with slower weight loss.
Recent studies by Dr. Paul O’Brien, M.D. a world-renown Lap-Band expert show that Lap-Band patients experienced weight loss that actually exceeded amounts lost by gastric bypass patients after a period of five years.
Remember it’s not a race, it’s a journey.
2. Lap-Band surgery is not for “Sweet Eaters”
It is commonly believed that sweet eaters are not good candidates for Lap-Band weight loss surgery though there is actually little evidence for this. Dr. Paul O’Brien studied 200 patients to see if this was true. Patients who had their bands for a year were asked to fill out a questionnaire regarding their sweet eating behavior. Results showed almost identical weight loss in the sweet eaters vs. the non-sweet eaters.
At oBand, you will get the proper nutritional guidance to optimize your success.
3. Lap-Band surgery will not resolve obesity-related health conditions.
Lap-Band has been shown to improve asthma conditions in 60% of patients, 65% of patients with diabetes have seen resolution of their condition after Lap-Band surgery, while 95% of patients successfully resolved their sleep apnea.
4. Lap-Band adjustments hurt
The needle used to adjust your band is extremely fine. Also, we will numb the area to help make your discomfort minimal.
oBand and The Affordability Factor
November 17, 2011
Our team of experts at oBand Surgery Centers will do our best to try and obtain coverage for your weight loss surgery through your insurance; unfortunately it is not always possible. If insurance is not an option, oBand® has financing options available for you to choose from.
The return on your investment to change your life forever through surgery at oBand may be realized in a few short years by potential tax savings, personal life-style savings and healthcare savings.
Tax Savings
You may realize potential tax savings in the year you finance or pay cash for your Lap-Band®. You may be eligible to receive thousands of dollars back depending on your adjusted gross income. IRS Publication 502 states you can deduct your medical and dental expenses when they total more than 7.5% of your Adjusted Gross Income.
For more information, see the IRS publication: http://www.irs.gov/publications/p502/index.html
Tax and financial circumstances are different for each person and the tax laws are constantly changing. This information should not be considered financial advice.
You should seek financial advice from a professional for any questions you may have.
Personal and Healthcare Costs
Are you on any medications for obesity related illnesses?
Have you ever missed work because of your health?
Do you spend money on weight loss programs like, Weight Watchers, Jenny Craig or other special diets?
Also by eating less, you spend less on groceries and eating out.
According to the June 2005 online version of the Journal Health Affairs, the cost of obesity can add up to $15,568 a year, including medications and food.
WEIGHT-RELATED COSTS
This includes:
Medical/Drug costs $5,965
Out of Pocket Healthcare Expenses $2,182
Employment Inactivity Costs $900
Commercial Weight loss Programs $600
Prescription Co-Pays $600
Grocery and Dining Costs $5,321
Total $15,568
If you add up all the costs related to being overweight, you may think that you can’t afford not to have something done.
Understanding Your Insurance
November 15, 2011
If you suffer from morbid obesity and you are contemplating bariatric surgery dealing with and understanding your health insurance may be a daunting task. The oBand® team of experts is here to help you with this process.
There are two ways you could be covered for medical insurance:
Fully insured policy- Insurance that you pay for yourself, or that is paid in full or in part by your employer. If the employer plan is fully insured, the insurance company is ultimately responsible for the healthcare costs, and your employer (or your spouse’s employer) typically purchases a standardized package of coverage. You may or may not have the benefit for bariatric surgery.
Self-insured policy - You may be covered by an employer’s self-insured medical benefits plan. With a self-insured plan your employer (or your spouses employer) is ultimately responsible for the healthcare costs. The insurance company is only the administrator of the plan. As with the fully insured policy the decision to have a benefit for bariatric surgery is fully up to your employer.
In either case (fully insured or self-insured) you should get a copy of your health insurance policy. Ask your human resources department at work or your insurance company for this. Often times this document can be downloaded from the Internet on a site that is specific to your employer.
You must review your policy to determine if you have an exclusion or inclusion for weight loss surgery. Exclusions are medical services not covered by an individual’s insurance policy. If your policy has an inclusion, this means that your policy covers bariatric surgery, under certain conditions and you will be required to meet certain criteria. The oBand® team of experts can help you determine whether you have an exclusion or the benefit (inclusion) for bariatric surgery. Unfortunately, not every insurance plan will cover bariatric surgery. In the event coverage is not offered, oBand® will continue to present your case if you are a candidate with extenuating circumstances. oBand® also has the ability to initiate an appeals process on your behalf.
Once we have helped you have determine the type of coverage you have we will assist you in getting pre-approved for your procedure. Pre-approval is required for weight-loss surgery.
It is advisable to keep good health records, this will make the process of getting you approved less complex. You should keep track of things like visits with your primary care doctor (including dates and any records documenting your height and weight), documentation of prior attempts to loose weight, health problems related to your obesity (such as diabetes, infertility, heart disease, etc.) and medications that you may be taking. Our expertise in submitting prior request authorization packages allows us to get you processed in a timely and efficient manner.
If insurance is not an option, oBand® has financing options available for you to choose from. Please contact us to explore your options.
